International partners working to fight the HIV/AIDS epidemic in Africa must broaden the roles of physicians, nurses and counselors in order to expand prevention and treatment programs across the continent, acting U.S. Global AIDS Coordinator Mark Dybul said on Tuesday at the third annual President's Emergency Plan for AIDS Relief meeting in Durban, South Africa, the AP/Mail & Guardian reports (Cullinan, AP/Mail & Guardian, 6/13). About 1,100 HIV/AIDS advocates, researchers and scientists gathered Monday for the five-day conference, which will focus on promoting HIV prevention issues including HIV testing, behavior changes and prevention of mother-to-child HIV transmission (Kaiser Daily HIV/AIDS Report, 6/13). "We need to expand four- or five-fold from where we are now to reach all those who need antiretroviral treatment," he added, "But it will take years to train enough doctors and nurses to manage this." He suggested broadening the roles of all health workers, including training nurses to perform some of the services provided by physicians, such as monitoring HIV-positive people on antiretroviral therapy, and training other health care workers to perform services generally provided by nurses, such as HIV counseling and testing. For example, in Uganda, "clinical officers" -- who are neither nurses nor physicians -- have been trained to monitor people living with HIV/AIDS who take antiretroviral drugs, the AP/Mail & Guardian reports. According to Dybul, PEPFAR -- which is scheduled to end in 2008 -- has bipartisan backing in the U.S., so "there is no question in anyone's mind that the U.S. will continue to support the fight against [HIV/]AIDS" (AP/Mail & Guardian, 6/13). PEPFAR might exceed its $15 billion funding target by 2008, which is a reflection of the U.S.'s long-term commitment to addressing HIV/AIDS worldwide, Dybul said Monday (Kaiser Daily HIV/AIDS Report, 6/13).

HIV Prevalence in Africa Higher Among Wealthy
HIV prevalence is higher among the wealthiest 20% of the population in Africa than the poorest 20%, according to a study presented at the conference on Tuesday, the Boston Globe reports. The study was conducted by ORC Macro and presented by Vinod Mishra, director of research at ORC Marco. Researchers interviewed 6,000 to 18,000 people in each of eight African nations and tested them for HIV. They did not ask people their income level but instead recorded a number of details about their residence and possessions to rank their wealth. In Uganda, HIV prevalence was 5% among the poorest 20% of women compared with 11% among the wealthiest 20% of women. In Ugandan men, HIV prevalence was 4% among the poorest 20% compared with 6% among the wealthiest 20%. "Poverty-driven programs are likely to have limited impact on prevention efforts when the majority of HIV-[positive] people are the wealthiest, not the poorest," Mishra said. According to Mishra, one reason HIV prevalence is higher among wealthier groups is that studies show they have more sex partners, "more opportunities to travel, more opportunities for casual sex," and wealthy men can afford to buy sex. He added that wealthier men in Africa start having sex at an earlier age than their less affluent counterparts. However, wealthier women generally begin having sex later than poorer women. Despite the higher HIV prevalence among wealthier groups, HIV/AIDS continues to disproportionately affect the poor because they often lack access to health care and proper nutrition, Mishra added. The results of the study were "debated in several corners around the conference," and some conference delegates questioned Mishra's conclusions, the Globe reports. "Ninety percent of the people in Africa are poor," John Lambert, a British development official, said, adding, "The danger is that people could say that AIDS affects the wealthy more than the poor people. [HIV/AIDS advocates] worry about that" (Donnelly, Boston Globe, 6/14).

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